脊柱均匀短缩脊髓轴性减压术治疗脊髓拴系综合征膀胱功能的分析

Homogeneous spinal-shortening axial decompression procedure for bladder function of tethered cord syndrome

中文关键词:  脊柱均匀短缩脊髓轴性减压术  脊髓拴系综合征  尿流动力学

英文关键词:Homogeneous spinal-shortening axial decompression  Tethered cord syndrome  Urodynamic

中文摘要:

  【摘要】 目的：评估脊柱均匀短缩脊髓轴性减压术（homogeneous spinal-shortening axial decompression，HSAD）后脊髓拴系综合征患者膀胱功能的改善情况。方法：回顾性分析我院2013年4月~2016年7月接受HSAD治疗的脊髓拴系综合征患者共16例，男6例，女10例，年龄11~64岁，平均29.9±16.7岁。术前、术后3个月、6个月、12个月及末次随访均采用国际尿失禁问卷简表（ICI-Q-SF）评分评估患者膀胱功能，术前及末次随访行尿流动力学检查，评估膀胱安全容量、逼尿肌漏尿点压、膀胱顺应性、残余尿量等指标变化情况。结果：16例患者均获得随访，随访15~54个月（32.4±10.1个月）。术前ICI-Q-SF评分为14.94±4.15分，术后3个月时为9.88±4.43分，术后6个月时为8.63±4.17分，术后12个月时为8.19±4.22分，末次随访时为7.63±4.40分，术后各次随访结果与术前相比差异均具有统计学差异（P＜0.05）。末次随访时，膀胱安全容量由术前155.31±75.33ml增加至252.69±64.94ml，差异有统计学意义（P＜0.05）。逼尿肌漏尿点压由术前43.12±17.96cmH2O降至30.44±13.96cmH2O，差异具有统计学意义（P＜0.05）；膀胱顺应性由术前8.56±5.78ml/cmH2O升高至23.10±12.05ml/cmH2O，差异具有统计学意义（P＜0.05）。膀胱残余尿量术前140.44±113.66ml减小至84.06±70.07ml，差异无统计学意义（P>0.05）。结论：HSAD可明显改善脊髓拴系综合征患者的泌尿功能及尿流动力学指标，是一种可供选择的治疗脊髓拴系综合征的手术方式。

英文摘要:

  【Abstract】 Objectives: To evaluate the outcomes of bladder function in patients with tethered cord syndrome (TCS) by homogeneous spinal-shortening axial decompression(HSAD). Methods: From April 2013 to July 2016, 16 patients(6 males, 10 females) with TCS, aged 11-64 years old(average, 29.9±16.7 years old), underwent HSAD. The ICI-Q-SF score was used to evaluate pre- and post-operative bladder function. The pre- and post-operative parameters, including safe bladder capacity, bladder compliance, detrusor leak point pressure and bladder residual urine volume, were measured according to urodynamic. Results: 16 patients were followed up for 15 to 54 months(average, 32.4±10.1months). The ICI-Q-SF score was decreased from preoperative 14.94±4.15 to 7.63±4.40 at final follow-up(P<0.01). The safe bladder capacity was increased from preoperative 155.31±75.33ml to 252.69±64.94ml at final follow-up(P＜0.05). The bladder compliance was improved from preoperative 8.56±5.78ml/cmH2O to 23.10±12.05ml/cmH2O at final follow-up(P＜0.05). The detrusor leak point pressure was decreased from preoperative 43.12±17.96cmH2O to 30.44±13.96cmH2O at final follow-up(P＜0.05). The bladder compliance was increased from preoperative 8.56±5.78ml/cmH2O to 23.10±12.05ml/cmH2O at final follow-up(P＜0.05) The bladder residual urine volume had no statistic difference(P>0.05). Conclusions: HSAD could obviously improve the urinary function and urodynamic indexes of patients with TCS.